Behavior Vs. Disease: A New Way To Look At Health

What is the leading cause of death in the United States? Heart disease? Cancer? No, it’s smoking. Smoking? Yes, depending on how you ask the question.

In the early 90s, McGinnis and Foege turned the age-old question of what people die of on its head by asking not what diseases people die??of but rather what the causes of these are. Instead of chalking up the death of an older man??to say lung cancer, they sought to understand the proximate cause of death, which in the case of lung cancer is largely smoking. Using published data, the researchers performed a simple but profound calculation — they multiplied the mortality rates of leading diseases by the cause-attributable fraction, that proportion of a disease that can be attributed to a particular cause (for example, in lung cancer 90 percent of deaths in men and 80 percent of deaths in women are attributable to smoking). Published in JAMA in 1993, their landmark study became a call to action for the public health community.

When??looked at??the conventional way, using data from the 2004 update of the original study, heart disease, cancer, and stroke??are the leading causes of death, respectively. This accounting may help us understand the nationa??s burden of illness, but does little to tell us how to prevent these diseases and improve health. Through the lens of McGinnis and Foege we get the??actual causes of??death (e.g., the major external modifiable factors that contribute to death). This analysis shows that the number??one cause of death in??America is tobacco use, followed closely by poor diet and lack of physical activity, and then alcohol consumption.

For those??who are??passionate about preventive health, we take heart that fully??six of the 10 leading actual causes of death are controllable behaviors — all except microbial agents, toxic agents, motor vehicle, and firearms (though handwashing and seatbelts can make a huge difference!) a?? and that??four of the 10 are addressed by U.S. Preventive Services Task Force recommended clinical preventive services.

You may wonder why am I presenting the results of a seven-year-old study that is itself an update of a paper published 18 years ago.??Two weeks ago, I attended the American College of Preventive Medicine’s annual scientific session. Along with hundreds of my peers, I went to the conference??excited to hear about the latest and greatest in preventive medicine. At??highly anticipated??keynote address, the opening speaker Dr. David Katz??presented the??first of what would be hundreds of slides of data shown throughout the three-day conference. And what did he kick off the conference with???The graphs above showing the top 10 actual causes of death in America.

Often when it comes to health it is hard to separate the signal from the noise. We get so many messages through the media, our social networks, and even our doctors: a??Heart disease is the number??one killer,a?? a??Eat more omega-3,a?? a??Dona??t forget to check your breasts.a?? There are only so many hours in the day and so many competing agendas, it is hard to know what to make a priority. Sometimes to sort it all out it helps to just step back and let the data speak for itself.

So the question is:??What does the data say to you?

- Shantanu Nundy, M.D.

                       

The Seven Golden Rules For Kidneys

In the better-late-than-never category comes my shout out for World Kidney Day, which was March 10th.

I love their slogan: a??Protect your Kidneys, Save your Heart.a??

As an organ, the kidneys are a lot like offensive lineman in football; they do all the hard work but remain mostly anonymous. They sit motionless in the back of the body,quietly and humbly filtering salt, water and toxins from our bodies. Though some may think that pee smells bad, or is gross, not having a??healthya?? pee is a real problem.?? No one ever thinks of their kidneys until they malfunction.

Though the inner workings of the kidneya??with all its convoluted loops, capsules and ion exchangersa??are more complicated to understand than the heart, keeping your kidneys healthy is simple: just make heart-healthy choices.

Only kidney peeps give their rules a far more creative namea?|

The Seven Golden Rules:

• Stay fit and active.


• Keep your blood sugar under control.


• Monitor your blood pressure.


• Eat well and stay thin.


• Do not smoke.


• Do not take over-the-counter pills on a regular basis. (NSAIDsa??Non-steroidal anti-inflammatory drugs are even harder on the kidneys than they are on the heart.)


• Check your kidney function if you have any of these risk factors. (Note: Unlike Echos and ECGs, a kidney function test is objective; the level of creatinine comes with an easy to read a??Ha?? or a??La??.)

Thata??s it, I have to goa?|

JMM

                       

Your Dog May Be Your Best Personal Trainer

Earlier this week there was an article in the NY Times by Tara Parker-Pope?? –Forget the Treadmill. Get a Dog. — which states in a more elegant way what I have been saying for years now.

a?|a?|Several studies now show that dogs can be powerful motivators to get people moving. a?|..

Just last week, researchers from Michigan State University reported that among dog owners who took their pets for regular walks, 60 percent met federal criteria for regular moderate or vigorous exercise. a?|a?|.

A study of 41,500 California residents also looked at walking among dog and cat owners as well as those who didna??t have pets. Dog owners were about 60 percent more likely to walk for leisure than people who owned a cat or no pet at all. a?|a?|..

I have called my dog Rusty my personal trainer.?? He never lets me off the hook.?? We walk daily regardless of the weather (hot, cold, rain, snow).

I also use a pedometer to remind me to get up and move more.?? It it a nice device to motivate me to not sit (& blog, read, knit, quilt) too much.

Herea??s a replay of my tribute to Rusty, My Personal Trainer (January 2010):

a??Five more minutes,a?? I tell him as he nimbly places his paws on my knees, brown eyes imploring.

a??Okay, you win.a??

Orange ball cap on my head, gloved hands grab the leash.

We exit the gate, the January sun cold as we jog toward the neighbors woods.

Will there be ducks on the pond today?

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Verification: The New Scam In Town

Therea??s a new scam in town.

Company calls over and over again (claiming to be the phone company, actually) just wanting to a??verify your addressa??. Over and over again they get told we arena??t interested, leave us alone, dona??t call. Finally, my solitary staffer gets sick of fending them off and goes through their voice activated a??address verificationa??, during which a mechanical voice asks questions, followed by a command to a??Say Yes or No, then press the pound key.a??

So she goes through the innocuous questions, including her full name, the office address and phone number, plus several iterations of saying a??Yes or No, then press pound.a?? The calls stop; everyone is happy.

Until I get the phone bill six weeks later. Lo and behold, there is an extra $49.99 charge (plus tax) from a company I never heard of. Multiple phone calls reveal it to be a company providing a??Internet optimization, web services, and a toll free number,a?? stuff I neither need nor want.

I call to complain. I am told there exists a recording of Solitary Staffer authorizing said services. Ia??ve actually heard this line before. a??Let me hear it,a?? I demand. What usually happens is that said recording a??cannot be found,a?? the services end up canceled, the account credited.

This time, though, they produce a recording of what is clearly SSa??s voice saying her full name, the office address and phone number, plus the word a??yesa?? several times. However the mechanical voice is saying things like, a??Do you agree that you are authorized to incur charges at this number,a?? which SS clearly is not, knows she is not, and to which she never ever would have responded a??Yesa?? and pressed the pound key.

Obviously they have taken clips of her voice and spliced them into whatever they wanted.

A nice touch is the a??30 day free trial perioda?? during which I could have stopped the service for free, the catch being that I received no notification until the phone bill six weeks later.

I yell, scream, moan politely demand that they discontinue the service and credit my account immediately. Although the first person I get on the line claims not to have the authority to do so, she puts me on hold for a while, then comes back and agrees to credit me $99.98 for the two billing cycles. Now I have to decide if ita??s worth calling the phone company to get the $6.00 credit for the damn tax.

Take home lesson: be very leery of calls for a??verification,a?? a word whose root comes from the Latin for a??trutha??, that now seems to portend naught but lies.

                       

iPad Cover Used In Kitchens Could Also Be Used In Hospitals

Apple iPads are taking the clinical world by storm, but they’re not exactly built for a busy environment full of liquids, dirty hands, and pathogens.  The Chef Sleeve is a plastic wrapping originally designed to help cooks prevent their iPads from getting hit by a splash of this and a dash of that.  The plastic is compatible with the touch screen, provides basic protection, and won’t require you to sterilize it before bringing it home from the hospital. At $20 for 25 sleeves, your new baby can get the basic protection it deserves.

Product page: Chef Sleeve…

                       

Technophobic Physician Discovers iPhone, Recommends Apps

Your humble Luddite Whistleblower has leapt across the??sea to reach the Isle of Technology. I now own and operate an iPhone, which identifies me as groovy, hip and cool, three adjectives that none of our 5 kids ever use to describe their technophobic father. Ia??m told that my text messages are too long and too frequent. I am admonished that it is not necessary for me to photograph moments of high drama, such as a kid eating breakfast, and then to disseminate the image to my contact list. I am reminded often that I am slow to grasp the mechanical intricacies of the device, such as switching from ring to vibration mode.

You may wonder how it was possible that I, who consider using an ATM to be a high level computer operation, could make the iPhone, my phone. I knew I couldna??t fail, despite my trepidation of all things cyber. I had a secret weapon, a a??Plan Ba??. Actually, I had Plan Z, the most powerful asset that anyone in my situation could hope for. Z stands for Zachy. One sentence will explain all and may provoke screams of envy from those who have no available similar resource.

Zachy is our 14-yr-old kid!

Zachy is our youngest son and lives and dreams in the cyberworld. Like his contemporaries, he relies on computers to communicate and interact with the world. He is excited to devise new mousetraps that seem unnecessarily complex. When he receives a phone call, he can reroute the call so that it the callera??s voice will emerge out of a speaker from another techno-contraption in his room. Is this cool? Yes. Is it easier than simply answering the phone? You decide.

Of course, the real appeal of the iPhone is the Apps. Since App to me means appendectomy, I assumed that the iPhone was a well-designed physiciana??s tool. Relax readers, I have since become educated and have increased my Apptitude. I can now spend time I dona??t have searching for cool Apps that will solve problems I dona??t have.

Some Apps I Have

Dragon a?? This is a must-have App and is well worth the price. Ita??s free. It permits you to dictate directly into the contraption and then transforms your voice into text with reasonable accuracy. This is great for TWD, or texting while driving, an act that no responsible physician has ever committed.

Epocrates a?? Another gratis App, although the company hopes you will upgrade to one of their premium products. Ia??ve used Epocrates for years, and consult it nearly every day. Ita??s a quick and easy resource for all medications, including dosage, adverse reactions, drug interactions, contraindications and cost. How many medications do we really need to take care of patients? Probably, 2 dozen or so.

Liver Calc a?? My partner is always showing off when he rounds on liver patients and calculates the MELD score in his progress notes. Who can remember this stuff? It reminds me of the Ranson criteria for pancreatitis that we medical students were forced to memorize. (I remember Dr. Ranson from my medical school days. He was warm & fuzzy a?? NOT). Do these liver scores help actual patients or merely provide grist for board examinations? With this App, I can now calculate on the spot a variety of scores for liver patients, most of which this board certified gastroenterologist has never heard of. Anyone out there heard of the RUCAM criteria?

Medscape a?? This is a very comprehensive site, but seems to cruise more horizontally across the medical landscape than vertically. Will I ever use it? Not sure. The goal, I am learning, is not to use Apps, but just to collect a??em.

Epocrates Disease Game a?? This is a cool way to spend time in the airport when your flight is delayed and the smiling airline personnel will not divulge the updated departure time regardless of threat or bribery. Tap the App and a medical image appears in stages, until the entire screen shows the finding. Choose the correct diagnosis among the 3 given choices. For those who were born during the Eisenhower era, this game reminds me of solving the rebus in the classic TV game show Concentration.

Apps I Want

Colon Cleanse App a?? This is a double plug in App. You plug in the device into the headphone jack of the iPhone and plug the larger end into the rectum. Attach the accessory funneled cleansing tube to a standard faucet, and watch the toxins disappear.

Medical Coding App a?? This turns your iPhone into a high voltage device, similar to the Invisible Fences that are used to restrain pets to a given area. Tap the App and then place the iPhone in your front pocket. After seeing a patient, if you code higher than you should on your EMR, you will get a light shock. The intensity will increase until you have expressed remorse, atoned and coded properly. I expect that Medicare will provide incentives for using this technology in the coming years.

Formulary App a?? This will be fun for the entire office. When the physician guesses the drug that is on the patienta??s formulary, carnival music starts blaring from the iPhone. Since this occurs rarely, do not worry that this App will be disruptive to your office routine.

Am I getting just a bit slAPP hAPPy? Probably, so. The APPendix may be a vestigial structure, but the iPhone Apps are like the oxygen drive. You can try holding your breath, but how long can you hold out?

                       

Medical Meeting Vendors Don’t Know How To Use Twitter Appropriately

Ia??ve been to several major medical meetings recently and Twitter is beginning to see traction.?? Slowly but surely Twitter hashtag use among doctors at meetings is growing.?? The vendors are there, too. I attended AGA/Digestive Disease Week this week and I have been unimpressed with the attempts of vendors to participate in the back channel. ??Those trying seem inept at real dialog.

Remember that a meetinga??s Twitter feed is a communication channel, not an opportunity for spam. ??Go ahead and remind us about your booth but only after contributing in a way that serves everyone in a non-promotional way (one pitch tweet for 10-20 informational tweets).

What works is sharing, not selling.????Take interest in the attendees.????Watch the feed.????Listen.????Re-tweet the interesting stuff. ??Share some breaking medical information. ??Reach out to attendees in a genuine, respectful way. ??And fear is no excuse a?? because the most memorable dialog will not involve your drug or medical device.

Start there and Twitter will work for not only for you but everyone.

                       

Inflammatory Bowel Disease Puts Patients At Risk For Some Skin Cancers

I stumbled across this review article (first full reference below) earlier this week.

Skin cancer is the most common form of cancer in the United States.?? Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems (such as inflammatory bowel disease patients on immunosuppressive therapy).

According to the National Cancer Institute (NCI), in there were more than one million new cases of nonmelanoma skin cancers (NMSC) in the United States in 2010.?? There were less than 1,000 NMSC deaths during the same time.

NMSC includes?? squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).???? Both occur more frequently on sunlight-exposed areas such as the head and neck. BCC is far more common than SCC and accounts for approximately 75% of all NMSC.

The causes of NMSC in the general public are multifactorial, including both environmental and host factors. Known environmental risk factors for NMSC include sun exposure (ultraviolet [UV] light), ionizing radiation, cigarette smoking, and certain chemical exposures such as arsenic. Host risk factors include human papilloma virus infection, genetic susceptibilities, skin type, and immunosuppression.

That last risk factor mentioned a?? immunosuppressiona??is one IBD patients have in common with solid organ transplant patients (kidneys, livers, lungs, face, hands).?? Note the third reference below.?? The results summary of that article

Two hundred patients developed a first NMSC after a median follow-up of 6.8 years after transplantation. The 3-year risk of the primary NMSC was 2.1%. Of the 200 patients with a primary NMSC, 91 (45.5%) had a second NMSC after a median follow-up after the first NMSC of 1.4 years (range, 3 months to 10 years). The 3-year risk of a second NMSC was 32.2%, and it was 49 times higher than that in patients with no previous NMSC. In a Cox proportional hazards regression model, age older than 50 years at the time of transplantation and male sex were significantly related to the first NMSC. Occurrence of the subsequent NMSC was not related to any risk factor considered, including sex, age at transplantation, type of transplanted organ, type of immunosuppressive therapy, histologic type of the first NMSC, and time since diagnosis of the first NMSC. Histologic type of the first NMSC strongly predicted the type of the subsequent NMSC

Attention is now being paid to other patients (ie IBD, rheumatoid arthritis) on immunosuppression and their increased risk of NMSC.

Millie D. Long, MD and colleagues (first reference) note that?? no IBD-specific, evidence-based guidelines for NMSC prevention exist.?? The current recommendations for prevention of skin cancer for the general population include sun avoidance and sun protection strategies include protective clothing, hats, sunglasses, and sunscreens.???? Sun avoidance should include tanning bed avoidance.

Any skin lesion suspicious for malignancy in a patient with IBD on immunosuppression should be evaluated by a trained dermatologist.?? Among solid-organ transplant recipients, annual skin examination is recommended by various transplant organizations.

Long and colleagues note a??There are no guidelines for skin cancer screening in patients with IBD, as it is unclear whether the riska??benefit ratio of skin cancer screening in IBD patients correlates with that of the general population, or more closely with that of the solid-organ transplant population. Consideration could be given in the future to skin cancer screening programs for patients with IBD on immunosuppression.a??

REFERENCE

1.?? Nonmelanoma skin cancer in inflammatory bowel disease: A review; Millie D. Long, Michael D. Kappelman and Clare A. Pipkin; Inflammatory Bowel Diseases Volume 17, Issue 6, pages 1423a??1427, June 2011; Article first published online: 25 OCT 2010 | DOI: 10.1002/ibd.21484

2.?? National Cancer Institute; Skin Cancer

3.?? Incidence and Clinical Predictors of a Subsequent Nonmelanoma Skin Cancer in Solid Organ Transplant Recipients With a First Nonmelanoma Skin Cancer: A Multicenter Cohort Study; Gianpaolo Tessari; Luigi Naldi; Luigino Boschiero; Francesco Nacchia; Francesca Fior; Alberto Forni; Carlo Rugiu; Giuseppe Faggian; Fabrizia Sassi; Eliana Gotti; Roberto Fiocchi; Giorgio Talamini; Giampiero Girolomoni; Arch Dermatol. 2010;146(3):294-299

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When Less Is More: How To Improve The Quality Of Primary Care

On the NPR Shots blog, Scott Hensley writes, “Quality Prescription For Primary Care Doctors: Do Less,” about an article in the Archives of Internal Medicine. Excerpt:

“A group of docs who want to improve the quality and cost-effectiveness of primary care tinkered with some Top 5 lists for of dos and don’ts for pediatricians, family doctors and internists.

After testing them a bit, they published online by the Archives of Internal Medicine. Most of the advice falls in the category of less is more.

So what should family doctors not be doing? The Top 5 list for them goes like this:

1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weeks or there are red flags, such as neurological problems.

2. No antibiotics for mild to moderate sinusitis, unless it has lasted a week or longer. Or the condition worsens after first getting better.

3. No annual electrocardiograms for low-risk patients without cardiac symptoms.

4. No Pap tests in patients under 21, or women who’ve had hysterectomies for non-malignant disease.

5. No bone scans for women under 65 or men under 70, unless they have specific risk factors.”

                       

Statins Reduce Heart Disease Risk, But Probably Not Because They Lower Cholesterol

When cyclists find out that I am a heart doctor, they most frequently ask about cholesterol numbers.

a??a?|My cholesterol is thisa?|What do you think?a??

a??a?|My doctor wants me to take a statina?|But I read that these drugs might lower my functional threshold power 2.014 watts/40km.a??

All this focus on numbers saddens me. Remember, I am a forest guy, not a tree guy. Whata??s more, as a doctor that revels in the adrenaline rush of ablating rogue circuits with technology that would impress even a twenty-something, I find questions about biochemistry drearya??like eating quinoa.

I wish folks would ask me about how to terminate AF with a catheter, or how an (evidenced-based) ICD saved a moma??s life, or perhaps even this: a??Do you do heart surgery?a??

But more often than not people want to know about cholesterol.

Okay. It just so happens that this week brought some very interesting news concerning the treatment of abnormal cholesterol lab values. News that big-picture docs have to like.

Here goes:

The AIM-HIGH trial, a large NIH-sponsored study which tested the addition of the HDL-raising drug Niaspan to a statin drug in patients at high risk of heart disease, was terminated early due to lack of benefit. The trial included patients with low levels of?? HDL (a??gooda?? cholesterol) and well-controlled LDL levels  (a??bada?? cholesterol). Most of the patients enrolled already had manifest heart disease, or they had a cluster of other risk factors, like obesity, diabetes and high blood pressure. These were truly high risk patientsa??a group that would be likely to benefit from higher levels of HDL.

Niaspan worked as intended: it did indeed raise levels of HDL. But the striking finding was that there was not any reduction in heart-related adverse events. The drug simply did not reduce a??harda?? endpoints, like heart attack, stroke and death.?? (In fact, there was a small increase in the number of strokes in the Niaspan group.)

How is this possible?

This finding seems counter-intuitive.  We know that low HDL levels are associated with a higher risk for heart disease; therefore it would seem logical that raising the level of the molecule would confer benefit. But such is not the case with drugs that increase HDL. (A 2006 study called ILLUMINATE revealed that another potent HDL-raising drug, Torcetrapib, actually increased the risk of heart events.)

I see three important lessens in this trial:

(1) Though low HDL levels are associated with a higher risk of heart events, it is clear that raising HDL levels with drugs is not helpful. Heart health doesna??t come from swallowing pills!

(2) The best way to increase HDL levels is through regular and vigorous exercise.

(3) The over-attention to levels of chemicals (medical people call them biomarkers) is problematic. When looking at a study which claims benefits, a reader should ask whether there were actual differences in outcomes. Changing the level of something (like cholesterol, blood sugar, or bone density) may not correspond to actual benefit. Always ask about outcomes.

Let me conclude with a comment about statin drugs. I strongly believe that statins lower the risk of heart-related events through actions on the blood vessel wall. They mitigate inflammation in the blood vessel. We cana??t measure this anti-inflammatory effect, so we measure cholesterol levels. But statins are different than other cholesterol-lowering drugs because they have favorable outcome data. Numerous trials have shown that patients at high heart risk of heart disease that take statins have fewer heart attacks and strokes.

Thata??s enough biochemistry quinoa.

References:

Here is the NIH press release for AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health)

More complete and academically rigorous accounts can be viewed on Cardiobrief and TheHeart.org.

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Thyroid Cancer: A Hazard From Radioactive Iodine Emitted By Japana??s Failing Nuclear Power Plants

One of the most abundant substances in the cloud of radioactive steam released by a failing nuclear power plant is iodine-131 — a radioactive form of the element iodine that is found throughout nature. Iodine-131 poses a special health risk because of its cancer-causing effect on the thyroid gland.

The small, butterfly-shaped thyroid sits just below the voice box. From this perch, it controls how fast every cell in the body changes food into energy. The glanda??s main product, thyroid hormone, governs the function of the digestive tract, brain, heart, nerves, muscles, bones, skin, and more.

Iodine is a key ingredient that goes into making thyroid hormone. We get this element from ocean-caught or ocean-farmed Fish-in-Water-Belt-Buckle-246.html' target='_blank'>fish and shellfish, milk, cheese, yogurt, eggs, and fruits and vegetables grown in iodine-rich soil.

The human body is surprisingly good at absorbing iodine and storing it in the thyroid gland. Thata??s a problem when iodine-131 is released into the atmosphere. The thyroid stores it as readily as natural, non-radioactive iodine. As iodine-131 builds up in the thyroid gland, it emits bursts of radiation that can damage DNA and other genetic material. Such damage can remove the normal limits to cell growth and division. Unchecked growth of thyroid tissue is thyroid cancer.

Iodine-131 gets into the body several ways. A person can breathe in radioactive steam released by a nuclear power plant. Fallout — radioactive particles that fall out of the atmosphere and settle onto plants, soil, and water — further adds to the burden when a person eats iodine-131 enriched fruits and vegetables or drinks water containing the isotope. Milk is another vehicle — cows that eat grass sprinkled with iodine-131 make milk that contains it.

Following the explosion and meltdown of the nuclear reactor at Chernobyl in 1986, follow-up health studies showed a significant increase in thyroid cancer in the area around Chernobyl, especially among children who were under 10 years old at the time of the explosion and those in utero. Youths may be most affected by iodine-131 because their thyroid glands are still growing and developing. Fortunately, as cancers go, thyroid cancer is one of the least deadly. In the United States, only about 5 percent??of people who develop thyroid cancer die of the disease. (Researchers arena??t yet sure if this applies to radiation-induced thyroid cancer.)

As my colleague Peter Wehrwein describes in a??related post, taking potassium iodide pills can help keep iodine-131 from taking up residence in the thyroid gland. The seafood-rich Japanese diet provides an abundance of iodine. Because the thyroid glands of those affected by fallout from the failing nuclear power plants may be a??fulla?? of natural iodine, iodine-131 may not be able to get into the gland, giving them natural protection against radiation-induced thyroid cancer.

- P.J. Skerrett, Editor, Harvard Heart Letter

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The Psychological Price Of Surviving Cancer

One of my closest friends is a two-time breast cancer survivor. Terry (as Ia??ll call her) has been cancer free for eight yearsa??long enough to be considered cured (generally defined as being in remission at least five years). But in no way is she a??freea?? of cancer. Every abnormal blood test, every callback for another mammogram terrifies her so badly she cana??t sleep until doctors rule out a recurrence. In some ways, the ongoing psychological and emotional challenges she faces have been worse than the physical treatments she endured.

I thought about Terry when I read the latest government statistics on the number of cancer survivors in this country. Nearly 12 million Americansa??4% of the populationa??are still alive after a cancer diagnosis.

In many respects this is terrific news, and a testament to improved diagnosis and treatment options. But survivorship comes at a psychological price. We discussed these challenges at length in the?? Harvard Mental Health Letter, but herea??s a quick look at some of the major issues.

a??Damocles syndrome.a?? According to Greek legend, once Damocles realized that a sword was dangling precariously over his head, he could no longer enjoy the banquet spread in front of him. In the same way, the specter of cancer hangs over some cancer survivors. They can become emotionally paralyzed and have a hard time deciding to get married, change jobs, or make other major decisions.

Fear of recurrence. Given cancera??s potential to lay dormant for a while and then spread (metastasize), cancer survivors often experience ongoing fear of recurrence. Follow-up medical visits, unexplained pain, or even sights and sounds they associate with treatment can trigger bouts of anxiety and fear that are as debilitating as those that occurred during cancer treatment.

Survivor guilt. Although happy to be alive, cancer survivors may feel guilty that they survived while fellow patients they became friendly with during treatment or as part of a support group did not. (Early after a diagnosis of cancer, people first ask, a??Why me?a?? When survivors think about those who have died, they tend to ask, a??Why not me?a??)

Recognizing these challenges, the Institute of Medicinea??s Committee on Cancer Survivorship explored ways to help people rebuild their lives after treatment ends. You can read the report, a??From Cancer Patient to Cancer Survivor: Lost In Transition,a?? for free online or buy it from the National Academies Press.

Given that one in three Americans will face a cancer diagnosis at some point in their lives, living with cancer is a topic that touches all of us. If you are a survivor, or know someone who is, these Web sites may be useful.

• American Cancer Society Cancer Survivors Network


• National Coalition for Cancer Survivorship


• National Cancer Institute: Cancer Survivorship Research

If you have suggestions for dealing with the challenges of cancer survivorship, please let us know in the comment section.

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Positive Message Of The Day

Source: thatshappy.blogspot.com via Dawn on Pinterest

                       

Food And Migraine Headaches: Triggers Are Hard To Predict

At a Harvard Medical School talk on migraine and food, a nutritionist from Harvard-affiliated Beth Israel Deaconess Medical Center delivered a message that people in the audience probably didna??t want to hear: a??There are no specific dietary recommendations for migraine sufferers,a?? said Sandra Allonen. But she did have some advice to offera??and she emphasized that the connection between food and migraine is a very individual one.

Several foods have been associated with triggering migraine. None of them has been scientifically proven to cause migraines, explained Allonen, but many people report a link between eating these foods and getting a migraine. Possible migraine triggers include:

• Aspartame (Equal, NutraSweet)


• Caffeine (Caffeine can help stop a migraine when it starts, but if you dona??t drink the same amount every day, caffeine withdrawal can trigger a migraine.)


• Chocolate


• Cultured dairy products, such as yogurt


• Broad beans, such as fava beans


• Nuts and nut butters


• Nitrates and nitrites, which are found in processed meats such as bacon and cold cuts


• Sulfites, which are found in wine


• Tyramine, which is found in aged cheeses and meats, and fermented beverages


• Yellow Dye Number 6, which is used in Doritos, Mountain Dew, and Peeps

Preventing migraines

Can you eat to prevent a migraine? Sadly, there arena??t any magical foods. But Allonen did say that keeping blood sugar steady throughout the day can be important. To do that, follow these tips. (Happily, they will help you keep your heart healthy as well.)

• Eat small, frequent meals


• Choose whole grains over processed grains (whole wheat bread vs. white bread, for example)


• Eat lean protein at every meal


• Keep hydrated

The most important prevention tactic may be keeping a daily headache diary, in which you write down everything you eat and drink, the activities you do, your stress level, and even the weather, along with how your head feels. It is a tedious activity, but a worthwhile one, especially when you start to see patterns emerge. For example, one person in the audience noted that she found she only got migraines when she ate pizza and chocolate at the same meal.

Allonen attributed the dearth of research into connections between migraine and food to finance: a??Therea??s no money in studying diet and migraine,a?? she said. With so little research being done in this area, you have to be your own personal researcher. And in reality, youa??ll probably learn the most this way, since it seems migraine triggers vary from person to person. After all, you dona??t want to cut chocolate out of your diet unless you truly have to.

                       

Emergency Rescue Essentials: The Outdoor Gear You Need

Wilderness medicine folks are often considered to be??a??gearheads.a?? That is, we love to try out new outdoor equipment, whether it is??for our activities, search and rescue, or personal safety. Improvisation is??important, but ita??s better to have what you need, particularly if you can pack??light and accomplish your mission without unnecessary bulk and weight. There??are numerous suppliers of equipment online. From time to time, as I am made??aware of these, I will let you know.

Rescue Essentials is a frequent exhibitor at wilderness medicine continuing medical education??meetings, and so I have become familiar with their carried product lines.

Importantly, Rescue Essentials carries the complete product line for SAM

Medical Products, which include the SAM Splint series and BlistOBan blister

(prevention) bandages. The company sells equipment for persons who respond to??outdoor medicine situations, tactical medics, search and rescue personnel, and??wilderness emergency medical technicians.

As a reminder of what a layperson might need to consider carrying??in order to be prepared to assist a person outdoors in need of medical??attention, here is a list that appears in the 5th edition of??Medicine for the Outdoors. From this list, one would select the desired items:

General Supplies

• medical guidebook


• first-aid report form


• pencil or pen with small notepad


• steel sewing needle


• paper clip


• safety pins


• needle-nose pliers with wire cutter


• sharp folding knife


• disposable scalpels (#11 and/or #12 blades)


• paramedic or EMT shears (scissors)


• Swiss Army?? knife or Leatherman??-type tool


• seam ripper


• sharp-pointed surgical scissors


• bandage scissors


• splinter forceps (tweezers)


• standard oral thermometer: digital, mercury, or
  
  alcohol


• low-reading hypothermia thermometer


• wooden tongue depressors (a??tongue bladesa??)


• rolled duct tape (3 in x 1 yd, or 91 cm)


• 1/8- to 1/4-inch-diameter braided nylon cord
  
  (minimum 10 ft, or 3 m)


• water bottle (such as Nalgene?? 1/2 to 1 liter)


• blue a??baby bulba?? or a??turkey bastera?? suction
  
  device


• waterproof flashlight (such as Pelican?? MityLitea?￠)


• headlamp (and spare batteries) a?? preferably with
  
  floodlight and flash settings, able to withstand moisture and temperature
  
  extremes


• CYALUME?? fluorescent light sticks


• CPR mouth barrier or pocket mask (such as a
  
  Microshield?? X-L Mouth Barriera?￠ or NuMask?? Pocket CPR Kit)


• sterile (hypoallergenic or latex) surgical
  
  gloves; if you are allergic to latex, bring other (such as nonlatex synthetic)
  
  nonpermeable gloves


• signal mirror


• magnifier


• waterproof matches


• fine-mesh head net or travel tent to repel
  
  insects


• Oral Rehydration Salts or Cera Lyte 70 oral
  
  electrolyte powder


• rubber cement


• urine pregnancy test

Wound Carea??Preparations and dressings

• elastic bandages (Band-Aid?? or Coverlet??),
  
  assorted sizes (strip, knuckle, and broad); cloth with adhesive is preferable


• Band-Aid?? Liquid Bandage


• butterfly bandages


• adhesive strips for wound closure (Steri-Stripa?￠
  
  or Cover-Strip?? II), assorted sizes (such as 1/4 in x 4 in, 1/8 in x 3 in, 1/2
  
  in x 4 in), reinforced (plain or impregnated with an antimicrobial) or elastic


• 3 in x 3 in or 4 in x 4 in sterile gauze pads
  
  (packets of 2 to 5) (such as Nu-Gauze?? highly absorbent)


• 5 in x 9 in or 8 in x 10 in sterile gauze
  
  (a??traumaa??) pads (packets of 2 to 5)


• nonstick sterile bandages (Telfa), assorted
  
  sizes


• 1 in, 2 in, 3 in, and 4 in rolled conforming
  
  gauze (C-wrap or Elastomull??)


• 1 in x 10 yd (9.1 m) rolled cloth adhesive tape


• 1 in x 10 yd (9.1 m) rolled paper or silk
  
  (hypoallergenic) adhesive tape


• 1 in x 10 yd (9.1 m) rolled waterproof adhesive
  
  tape


• 1/2 in x 10 yd (9.1 m) rolled waterproof
  
  adhesive tape


• Blist-O-Ban?? blister bandages (assorted sizes)


• Molefoam (41/8 in x 33/8 in)


• Moleskin Plus (41/8 in x 33/8 in)


• Spenco?? 2nd Skin?? (1.5 in x 2 in, 3 in x 4 in, 3
  
  in x 6.5 in) and Spenco?? Adhesive Knit Bandage (3 in x 5 in)


• Aquaphor moist nonadherent
  
  (petrolatum-impregnated) dressing (3 in x 3 in)


• Hydrogel occlusive absorbent dressing (4 in x 4
  
  in x 1/4 in)


• Tegaderm?? transparent wound dressing (also comes
  
  in combination with a Steri-Stripa?￠ in a Wound Closure System)


• liquid soap


• sterile disposable surgical scrub brush


• cotton-tipped swabs or applicators, sterile, 2
  
  per package


• safety razor


• syringe (10 ml to 60 ml) and 18-gauge
  
  intravenous catheter (plastic portion), for wound irrigation (do not use plastic disposable syringes
  
  to administer oral medications, as the small caps can dislodge and
  
  inadvertently eject into the patienta??s throat.)


• Zerowet Splashield or Supershield (2)


• tincture of benzoin, bottle or swabsticks


• benzalkonium chloride 1:750 solution (Zephiran)


• povidone iodine 10% solution (Betadine), 1 oz
  
  bottle or swabsticks


• suture material (nonabsorbable monfilament nylon
  
  on curved needle, suture sizes 3/0 and 4/0; consider sizes 2/0 (thicker) and
  
  5/0 (finer)


• stainless-steel needle driver


• disposable skin stapler (15 staples)


• disposable staple remover


• tissue glue

Splinting and Sling Material

• cravat cloth (triangular bandage)


• 2 in, 3 in, and 4 in elastic wrap (Ace)


• 4 1/4 in x 36 in SAM?? Splints (2)


• aluminum finger splints


• Kendrick?? femur traction device

Eye Medications and Dressings

• prepackaged individual sterile oval eye pads


• prepackaged eye bandages (Coverlet?? Eye
  
  Occlusor)


• metal or plastic eye shield


• sterile eyewash, 1 oz (30 ml)


• contact lens remover (or mini-marshmallows)


• ofloxacin, moxifloxacin or gatifloxacin eye
  
  drops


• oxymetazoline hydrochloride 0.025% eye drops

Dental Supplies

• oil of cloves (eugenol), 3.5 ml


• Cavita?￠, 7 g tube


• Intermediate Restorative Material (IRM??)


• Express Putty


• zinc oxide powder


• dental floss


• mouth mirror


• paraffin (dental wax) stick


• wooden spatulas


• cotton (rolls and pellets)

Topical Skin Preparations

• hydrocortisone cream, ointment, or lotion (0.5
  
  to 1%)


• potent corticosteroid ointment


• bacitracin ointment


• mupirocin ointment


• mupirocin calcium 2% cream


• bacitracin-neomycin polymyxin B sulphate
  
  ointment


• miconazole nitrate 2% antifungal cream


• silver sulfadiazine 1% (Silvadene) cream


• insect repellent


• sunscreen lotion or cream


• lip balm or sunscreen


• sunblock


• Adolpha??s meat tenderizer (unseasoned)


• Kenalog in Orabase (oral adhesive steroid for
  
  canker [mouth] sores), 5 g container


• aloe vera gel


• hemorrhoidal ointment with pramoxine 1%

Nonprescription Medications

• buffered aspirin, 325 mg tablets


• ibuprofen, 200 mg tablets


• acetaminophen, 325 mg tablets


• antacid


• decongestant (such as pseudoephedrine) tablets


• decongestant (such as oxymetazoline) nasal spray


• loperamide
  
  (Imodium A-D), 2 mg caplets


• Glutosea?￠ (glucose) gel tube


• stool softener (such as docusate calcium, 240 mg
  
  gel caps)


• caffeine, 200 mg tablets (to stay awake for
  
  survival purposes, such as during a rescue)

Prescription Medications

Select from this list, and from information throughout this

book, what you feel you might need; the drugs listed are for example.

• Pain medication(s): e.g., hydrocodone 5 mg with
  
  acetaminophen 500 mg


• Asthma medication(s); e.g., metered-dose
  
  bronchodilator (albuterol)


• Allergy medication(s): e.g., epinephrine
  
  (injectable) and prednisone, 10 mg tablets


• Antibiotics: e.g,


• penicillin V potassium, 250 mg tablets


• azithromycin, 250 mg tablets


• dicloxacillin, 250 mg tablets


• ampicillin, 250 mg tablets


• amoxicillin-clavulanate, 500 mg tablets


• erythromycin, 250 mg tablets


• cephalexin, 250 mg tablets


• ciprofloxacin, 500 mg tablets


• tetracycline, 500 mg tablets; or doxycycline,
  
  100 mg tablets


• trimethoprim-sulfamethoxazole, double-strength
  
  tablets


• prochlorperazine (Compazine) suppositories, 25
  
  mg


• promethazine (Phenergan) suppositories, 25 mg

Allergy Kit

• allergy kit with injectable epinephrine (EpiPen??
  
  auto-injector [0.3 mg] and EpiPen?? Jr. auto-injector [0.15 mg]; or Twinject?? 0.3
  
  or 0.15 mg auto-injector)


• diphenhydramine, 25 mg capsules

For Forest and Mountain Environments

• water disinfection equipment or chemicals (such
  
  as Potable Aqua tablets or Polar Pure iodine crystals)


• calamine lotion


• SPACE?? Emergency Blanket (2 oz, 56 in x 84 in)
  
  (alternatives include Pro-Tech Extreme bag or vest,?? SPACE?? brand emergency bag, SPACE?? brand
  
  all-weather blanket)


• hypothermia thermometer


• hyperthermia thermometer


• whistle


• acetazolamide (Diamox), 250 mg tablets


• dexamethasone (Decadron), 4 mg tablets


• nifedipine (Adalat CC), extended-release 30
  
  preparation


• powdered electrolyte beverage mix (Oral
  
  Rehydration Salts)


• instant chemical cold pack(s)


• hand warmer (mechanical or chemical)


• Kendrick?? Traction Device (leg splint)

For Aquatic Environments

• waterproof dry bag or hard case (such as Pelican
  
  Case, Storm Case, or OtterBox), to carry first-aid supplies


• motion sickness medicine


• acetic acid (vinegar) 5%


• isopropyl
  
  alcohol 40%


• hydrogen
  
  peroxide


• VoSol
  
  otic solution


• Ofloxacin 0.3% ear drops


• Safe Sea?? Sunblock with JellyFish-in-Water-Belt-Buckle-246.html' target='_blank'>fish Sting
  
  Protective Lotion

A sole supplier, such as Rescue Essentials, will be unlikely??to have everything you need for every situation, but it is a good place to??begin to get a handle on what is available and what the cost is to consumers.

Remember: allow yourself enough lead time prior to any outdoor adventure in??order to gather your belongings and to be properly prepared.

                       
                       

This post, Emergency Rescue Essentials: The Outdoor Gear You Need, was originally published on
                        Healthine.com by Paul Auerbach, M.D..

Making Sure You Have The Right Diagnosis: Tips From An Internet-Savvy Patient

People generally have a sense there might be information on the Web that can help them when they are worried about their health. They also have a sense there is a LOT of information and some of it may be wrong. All of that is true. What is a strategy to find the good and avoid the bad?

This morning, I chatted with Mike Collins, host of a??Charlotte Talksa?? on WFAE, public radio in Charlotte, North Carolina about The Web-Savvy Patient and some of my a??Insider Tipsa?? within.  We talked at length about how you can get started looking for health information on the Web.

First of all, if youa??re worried about your health, make sure you get an accurate diagnosis, and make sure that diagnosis is specific to you.  Dona??t be satisfied if your health care team tells you that you have a a??thyroid problem.a?? Find out if it is hyperthyroidism or hypothryroidism. It makes a big difference. If you dona??t know what you have you will find yourself wandering all over the Internet, discovering information that wona??t be right for you. You might be lead to believe that you have a brain tumor, rather than a migraine induced by monthly hormones or the effects of too much coffee (we know that one here in Seattle!). So rule #1 is know the details of your diagnosis and if you dona??t feel confident, recognizing some people are misdiagnosed, get a second opinion to confirm it. Then, and only then, should you start your search online.

There are many tips in my book about how to search for reliable information and Ia??ll blog about them as time goes on, but I invite you to share your tips too. What piece of advice did you receive that changed the course of your health care journey?

One other point about figuring out where to start looking for information on the Internet: Today there are many, many online communities of patients waiting to help a?? even for the rarest of conditions.  Thata??s how I found out about Dr. Keating and the clinical trial that beat my leukemia. One great example is www.bensfriends.org. Ben Munoz is a whiz at developing web sites but he also almost died of a stroke caused by a brain aneuryism. After he recovered, Ben teamed with other tech whiz kids to an start online community for his condition and now has built communities for many others too. Now, if someone knows their diagnosis is a brain aneurysim they can get help from Ben and his friends online. But knowing what you are dealing with is the place to start.

Wishing you and your family the best of health!

Andrew

                        �

How To Stop Bleeding: The Combat Application Tourniquet And QuikClot

The Combat Application Tourniquet Dr. Brad Bennett provided an excellent workshop at the 2010??Wilderness Medical Society annual meeting in Snowmass, Colorado on how to??manage severe bleeding, based on his work with the Committee on Tactical Combat??Casualty Care. From time to time,

wilderness medicine practitioners encounter situations of severe bleeding, so??this information is essential for anyone responsible for the health and safety??of outdoor explorers and adventurers.

In a simple algorithm, we learned that the first attempt to??control bleeding is almost always direct hand pressure. This is followed by??application of a pressure bandage. If that is successful, the victim then is??evacuated. If the pressure bandage does not adequately control bleeding on the??torso of the victim, then a hemostatic (stops bleeding) substance is applied??prior to evacuation. If bleeding from an arm or leg threatens the victima??s??life, a tourniquet may be required. A hemostatic agent that is being used with??increasing frequency is QuikClot Combat Gauze. Tourniquets include the Combat

Application Tourniquet (a??C-A-Ta??). Using any of these modalities requires??instruction and preparation.

QuikClot is composed of microporous,??aluminosilicate minerals (zeolite), and does not release heat when applied to the??site of bleeding. It can be integrated into woven kaolin-impregnated gauze. The??kaolin causes rapid blood clotting where the gauze is applied and is not??absorbed into the body. The gauze is safe to leave in the wound until further??medical care becomes available. To use the gauze, one opens clothing around the

wound, and then if possible, removes excess pooled blood from the wound while??preserving any blood clots that have already been formed in the wound. The most??active source of bleeding should be located and the gauze packed tightly in to??the wound directly on the source of bleeding. It may be necessary to use more

than one gauze roll. It is very important to remember that after the gauze is??packed into the wound, pressure directly over the bleeding must still be??applied continuously for a minimum of three minutes or until the bleeding??stops. The packed portion of the gauze is then anchored in place by wrapping??and tying the remainder of the bandage, or using another bandage, to maintain??pressure.?? If the bleeding continues to

briskly soak through the gauze, then the wound may be repacked with the??original gauze (or new gauze if available) to more accurately apply pressure.

A tourniquet is used on an arm or leg to stop bleeding from??a survivable wound. The Combat Application Tourniquet (C-A-T) is a small and??lightweight one-handed (i.e., the victim can self-apply the tourniquet)

tourniquet that completely occludes arterial blood flow in a limb. To apply??this tourniquet, it is ideally placed on the bare arm or leg a few inches above??the site of bleeding (between the bleeding and the heart). Next, one pulls the??self-adhering band to tightness and securely fastens it back on itself.?? Then, the windlass rod is twisted until??bleeding has stopped. The windlass rod is then locked in place with the??windlass clip. Then, the self-adhering band is adhered over the windlass??rod.?? To complete the process, everything

is secured by grasping the windlass strap and pulling it tightly and then fastening??it to the opposite hook on the windlass clip. Obviously, it is important to??practice with the device prior to attempting to use it in a critical??life-threatening situation.

There are a few tips for tourniquet users. One may need a??second tourniquet between the first tourniquet and the heart if bleeding is not??controlled with the first tourniquet. One should not place a tourniquet

directly over a knee or elbow, because it may not be effective. One should not??place a tourniquet directly over a pocket that contains bulky items. Tighten??the tourniquet enough to eliminate any arterial pulsation beyond the??tourniquet. Whenever a tourniquet is used, it is important to expose and??clearly mark all tourniquet sites with the time of tourniquet application with??an indelible market. This is important because it will help medical personnel??understand the situation with the treated limb and perhaps estimate the chance??of survival for tissue that has been deprived of blood flow. If a tourniquet is??applied, understand that loosening it periodically to allow circulation to??return to the limb might well cause unacceptable additional blood loss, so??should not be done. Do not loosen or remove the tourniquet if the victim will

arrive at a medical treatment facility within two hours after time of??application, if it has been in place for more than six hours, or if the limb??beyond the tourniquet has been amputated. If one decides to loosen or remove a??tourniquet because the bleeding is felt to be controlled, then it must be??loosened slowly while observing for bleeding. Preferably, one is immediately??able to apply a hemostatic bandage (described above) to the wound under a??pressure dressing. The tourniquet is left loosely in place in case it needs to

be re-tightened.

                       
                       

This post, How To Stop Bleeding: The Combat Application Tourniquet And QuikClot, was originally published on
                        Healthine.com by Paul Auerbach, M.D..

Fragmented Care Requires Clarification Of Roles By Each Member Of The Medical Team

a??The most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.a??

This was not some sweet ing??nue recounting the early lessons she learned from a recent encounter with health care.?? Nope.?? It was a 62-year-old woman whose husband has been struggling with multiple myeloma for the last eight years and who herself has chronic back pain, high blood pressure and high cholesterol and was at the time well into treatment for breast cancer.

Part of me says a??Ahem.?? Have you been paying attention here?a?? and another part says a??Well of course!?? How were you supposed to know this??? Have any of your physicians ever described their scope of expertise or practice to you?a??

I can see clinicians rolling their eyes at the very thought of having such a discussion with every patient.?? And I can imagine some of us on the receiving end thinking that when raised by a clinician, these topics are disclaimers, an avoidance of accountability and liability.

But all of us a?? particularly those receive care from more than one doctor a?? need to have a rudimentary idea of what each clinician we consult knows and does. Why is this clinician referring me to someone else? How will she communicate with that clinician going forward? How and about what does she hope I will communicate with her in the future?

Why does our clinician need to address these questions?

Because in the absence of real guidance we will guess.?? Some of us will make informed guesses and be mostly right. Others of us will leave our primary care provider in the dust and seek care for routine health matters from our specialist, whom we see more frequently and who seems to know us better. Some of us, like my friend above, will ask for help from whichever physician is handy and will call back, regardless of the problem.?? And some of us will throw up our hands in frustration and head for the local emergency department when we find we cana??t breathe and dona??t know which of our doctors to consult about those damn allergies.

These ad hoc solutions are a waste of our time and surely contribute to a poor use of clinician and institutional resources.

Fragmentation of health care and lack of coordination of services are widely recognized as problems.?? Considerable efforts now aim to improve communication among providers when a person leaves the hospital, for example, and great stock is placed in the potential of the new patient-centered medical homes to a??coordinatea?? our care (although the parameters of such coordination have yet to be defined).

There has been little or no recognition, however, of the fact that we patients and our families and loved ones are the main coordinators of all care: We decide when a threshold of discomfort has been crossed and we need professional help.?? We decide from whom and in what setting to seek such help.?? And for the foreseeable future, unfortunately, we choose to share the test results and treatment plans from one of our clinicians with another a?? or not. ??And we are doing this without guidance.

What would guidance look like?

Well, it doesna??t look like a website.?? More likely it has clinicians taking these small steps:

Clearly introducing their expertise, their experience and their role relative to other clinicians caring for us.?? This needna??t be highly technical or take a lot of time but it does need to differentiate one cliniciana??s role from other specialistsa?? or primary care providera??s, anticipating that I and my caregivers may be confused about which problem is best addressed by which doctor.?? Connie Davis, a geriatric nurse practitioner in British Columbia, says, a??When I introduce myself to the patients I serve, I say, a??Ia??m a geriatric nurse practitioner. Have you ever worked with a nurse practitioner before?a?? If they havena??t, I tell them that I am a nurse with additional training, so I am somewhere between a nurse and a doctor and that I work with older adults to address common health concerns and make sure everything is working as well as possible.a??

Giving simple but full explanations about referrals: why, to whom, for what, expectations about ongoing care and future communication, both between physicians and between the referring clinician and the patient.?? Such an explanation lays out a template for us to more easily find the right solution to the current problem.?? Further, many of us assume that because the receptionist uses a computer, our records are automatically electronically (and magically) transmitted to every other physician to whom we are referred.?? We cana??t do our part to support inter-physician communication if we believe it is being done for us already.

Saying a??Thata??s not my area of expertise.a?? As someone who is a??doctored upa?? with about 15 physicians treating me right now, I sometimes guess wrong about what any one of them considers within their expertise.?? I get a little frustrated but am ultimately reassured when one of them responds to my question with a??Not my body part,a?? or a??You need to talk to your primary care provider about that.a???? A survey released this week by the National Alliance on Mental Illness found that patients and family members are concerned when their doctors dona??t tell them they lack expertise about a condition: 75 percent of parents of kids with mental illness who were surveyed doubt their primary care providersa?? abilities to treat their kids effectively.?? Ita??s difficult to establish a a??continuous healing relationship,a?? as the Institute of Medicine report Crossing the Quality Chasm encourages, when questions about clinician competencies are not directly addressed.

Dona??t get me wrong. System-level fixes such as ??tailored online information, interoperable electronic health records with good patient portals and enhanced primary care will ease some of the redundancy and fill some of the gaps that now by default (and often without our recognition) fall to us to patch together. ??But at the end of the day, ita??s my mom deciding whether to call the cardiologist, the neurologist, the geriatrician or 911 about my disabled dada??s sudden dizziness.?? Shea??s the one who coordinates his care.

She also needs help from her clinicians to fulfill this responsibility.?? As do we all.

                        n

Superfocus Glasses May Improve Vision In The E.R.

As I  write this post, Ia??m wearing my new Superfocus glasses. I was given the glasses  by the company to demonstrate, and they are nothing less than remarkable. Ia??ve  used them mostly in two very common settings for mea??indoors and outdoors. In  both situations, they performed very well.

Superfocus  lenses work by mimicking a young, healthy human eye. Each lens is actually a  set of two lenses (flexible and firm). The flexible, inner lens has a  transparent membrane attached to a rigid surface, sandwiching a small amount of  clear fluid. The bridge (across the nose) connecting the lenses allows you to  adjust the shape of the flexible lens. Slide the tab along the bridge to find  the exact correction for the particular user. The intent is to achieve clear,  undistorted vision within any lighting or distance.

You can  learn a great deal from the Superfocus website about the benefits of adjustable  lenses, how to obtain the glasses, and so forth. I wona??t reiterate information  from the website, but rather discuss how I have used these glasses and discuss  their performance based on my own experience.

First, I  used them during my work in the E.R. as a physician. Because I am growing older  and having difficulty with near vision (I need to wear bifocals or reading  glasses), I have had difficulty achieving perfectly focused vision recently  when??working up closea??for instance when sewing patients’ wounds and in  other situations that require near vision. Using my reading glasses or the  lower part of my bifocals has been helpful, but not entirely satisfactory,  since I am restricted with these glasses to one distance because of  the??fixed-focal-length lens. Limited to a few mandatory distances with the  reading glasses and bifocals, if I need to lean back or otherwise change the  distance at which I am working, it sometimes becomes difficult to attain visual  focus. The Superfocus glasses entirely solve this problem. With a very quick  and easy adjustment using the slider, I can achieve perfect focus and then  adjust it again if my working distance changes.

Superfocus glasses

Another  observation is that the angle of tilt when wearing the glasses is important for  precision focusing, so that the glasses need to fit properly.??Prolonged  use with improper fit might cause eye strain and fatigue. Recognizing the importance  for frames to fit properly, the company provides a certificate good for $50 to  cover professional fitting fees by an optician. Superfocus also explains the  eyeglass construction to the eye care professional, to avoid inadvertent damage  during the fitting.

The only  issue in my work environment??is when I am required to wear sterile gloves.  Since I need to keep my hands sterile, the matter of manipulating the  slidera??having to a??break scrub,a?? move the slider, then put on a new pair of  glovesa??makes using the glasses a little more complicated. Luckily, the  Superfocus glasses allow a reasonable range of focus at a given setting, so  unless I am changing position substantially, a single setting has generally  been adequate for an entire procedure.

Next, I  wore the glasses outdoors while hiking. They worked very well, completely  solving the problem created by the split focus associated with bifocals. Using  the Superfocus glasses adjusted for distance vision, I didna??t have the blurry  bottom phenomenon created by the bifocals, and found it much easier to  negotiate steps and other inclines, particularly on the downhill  portions,??where glancing or looking down is important. For the future, I  will need darkened front lenses (these are available) for sustained outdoor  recreational or field work use, as well as for reading outdoors. Another added  benefit of Superfocus is that at the position of nearest focused range, there  is a small amount of magnification, which is definitely useful when inspecting  something up close (for example, to remove a thorn or splinter.

Superfocus  glasses are a winner, and function as advertised. They will be with me now when  I am trekking, camping, and fishing. For certain, I will use them when I serve  as medical support in an expedition setting, and for my global relief work.  They are comfortable and eliminate the need to carry additional reading  glassesa??although ita??s always recommended to carry backup glasses for all  distances when in a wilderness or??other remote or austere??setting. I  suggest carrying Superfocus glasses??in a sturdy case (provided with the  glasses) and wearing them with a lanyard, Chums, or other retainer, since they  are not inexpensive to replace.

                       
                       

This post, Superfocus Glasses May Improve Vision In The E.R., was originally published on
                        Healthine.com by Paul Auerbach, M.D..